This is the second installment of six about our struggles with infertility. Read part one here. This is our story, nothing more, but we share it to add another voice to this often unspoken struggle.
Early into our relationship, before we were ready to try conceiving, I made a declaration. “If we can’t have a baby naturally, I don’t want to do a bunch of fertility medications or treatments. We’ll just accept our fate and consider other options.” My husband nodded in agreement, and we changed the subject.
That’s an easy statement for a naïve woman who doesn’t understand fertility to make.
You don’t plan for infertility, unless you have had some major health issues, such as cancer. You expect to get pregnant like others around you, easily and naturally. Most women are taught their entire lives to avoid pregnancy until the exact moment you are ready (aka, married), and then it should just happen.
Before my infertility diagnosis, I saw women undergoing fertility treatments as desperate and wasteful. Why would you spend all of that money and put that medicated stress on your body when there are other options? If that was me, I thought, I would either lean into adoption or simply embrace my childless life.
Then I was put in that spot. My attitude flipped, and I realized how catty, mean, and judge mental my previous opinions were. After two and half years of trying naturally, it was clear that my husband and I could not get pregnant on our own. We would need medical intervention. I simply couldn’t accept that becoming a mother was not my path, and I wasn’t ready to consider adoption. I wanted, and still want, to be pregnant, and so we would dive into the world of fertility treatments, completely disregarding what I had said previously.
IUI, or intrauterine insemination, was the first step. I was OK with IUI. It seemed less invasive, physically and financially, than IVF (in-vitro fertilization). During the IUI process, a man’s specimen is washed down to the strongest and most capable sperm. It is then inserted into the woman’s uterus, cutting down on distance and giving the sperm and egg a better shot at connecting. Our fertility doctor agreed that with a male factor infertility diagnosis IUI was a good first step.
Our first cycle was unmedicated, meaning we did not use any medication to stimulate the follicles. Rather, they developed and matured on their own. I went to several appointments within the span of a week to see how they were growing. The ultrasound tech often pointed the monitor toward me as she moved the probe around, showing me what she saw. We were looking for big black blobs, which were follicles that held my eggs. My doctor wanted at least one to measure around 18-20, and on my final appointment, one on my right side was clocking in at 20. It was time.
The nurse called with instructions (fun fact: this 15-minute conversation cost $150). I needed to track my ovulation with strips, and if I had not ovulated on my own by the next morning, I would need to give myself a trigger shot. Also, I needed a rapid COVID test. The fertility staff wouldn’t not administer the IUI unless I produced a negative COVID test. She gave me more instructions about what to do, and then we scheduled the IUI two days later, on Sunday morning.
All of this was exciting but also stressful. I was on my way to work at my part-time retail job when the nurse called, and there were several things we needed to do before businesses shut down for the weekend. I did not have a trigger shot, so my nurse sent a prescription to a specialty pharmacy. It took a few hours for them to receive the order and double check insurance (most fertility medications are not covered by insurance), and then I had to sign a waiver for it. By the time it was ready, I was already at work, so my husband had to take the train for 30 minutes to get the prescription and then haul it back home in packaging that included an icepack.
Then, I needed to take a rapid COVID test. The clinic had given me one, as part of their now standard procedure for patients undergoing treatments, but it had since expired. The nurse explained that I would need to present my negative results at my Sunday appointment before they would move forward. The test at the clinic was my first COVID test. During the pandemic, my husband and I were fairly safe, and we had not come in contact with someone who had tested positive for the virus. There was never a need for us to get one. I’ve been fully vaccinated since February, and so my fears around getting COVID had been low.
However, the day before the nurse called to say we were going forward with the IUI, I had learned that a high school kid that I sometimes work with recently tested positive. He tested after a football teammate announced his positive status. I had just worked with the kid the weekend before, prior to him testing positive. Even though I was vaccinated and showing no symptoms, there was a chance that I could have contracted COVID, therefor producing a positive result and further delaying our procedure.
There is a former Mini-Cooper dealership in Chicago’s Lakeview neighborhood that’s been transformed into a COVID clinic that offers tests and vaccines. It wasn’t far from my work, and they took late appointments, so I went after my shift. The nurse was skeptical that I even needed the test, as I was fully vaccinated and not showing symptoms, but I explained that I couldn’t go through with the fertility treatment unless I did a rapid test. She shoved the q-tip up my nose anyway. It was more than a bit ironic that I had avoided this this virus for more than a year, and to have my biggest scare right before fertility treatments seemed cruel (not to mention that my graduation was a week away, so if I was positive, I wouldn’t be able to attend the ceremony). I joked to my coworkers that if it was positive, I would quit, which was more of a threat, as if it was something they could control. I called my mom on the drive home as a distraction while waiting for the results. When I parked the car, I had a text that my results were in.
Negative.
Our IUI appointment was for 7 a.m. on Sunday morning. I didn’t sleep well the night before, wondering if we had completed the preparation instructions properly. My ovulation predictor test showed a clear positive, but I went back and forth if I should still give myself the trigger shot. I tried to call the clinic, but it was a Saturday, and they would charge me $50 for a non-emergency call. I Googled it as much as I could, but as per usual, the answers were inconclusive. The window to take the shot was only a few hours, so after rereading the nurse’s instruction, I decided against the trigger shot.
We expected the clinic to be dead, but it was not. There were several other cars parked outside, hazard lights on, dropping off and picking up. My husband needed to go in first and present his sample. Because of COVID, we couldn’t go in together, and I stayed in the car and read a card that a dear friend had sent me. I received it a few days prior but had saved it for a time when I knew I would need some support from a loving person. He wasn’t gone long, though, and said that I needed to wait 30 minutes and then go in. We got some coffee at a nearby Dunkin and then he dropped me off at the clinic.
I am used to long waits at the clinic, but as soon as I checked in, they called my name. A nurse took me back into a part of the clinic I had not been before and started to prepare me for the procedure. I showed her my negative COVID test, and she asked me to read and confirm my name and my husband’s name. Then, I laid back and she did the insemination. I clutched a small keychain with a pineapple and vial of “baby dust” that a dear friend had sent. There was mild pain but not bad. It was done within minutes.
My husband and I went to breakfast after, filling in gaps of time before either of us had to be at our retail jobs. When the waitress came around with coffee, I declined. My body wasn’t yet pregnant, but it could be soon so I must act pregnant.
The next week was my graduation, followed by a short trip to see family who we hadn’t seen in more than a year due to the pandemic. I figured these big events would be enough commotion for me to forget about the two-week wait and what was happening in my body, but it was not.
It’s easy to forget that not all women understand the ins and outs of conception the way couples with infertility do. For those desperate to get pregnant, the two-week wait (TWW) is a necessary angst. For other women, those who are surprised by their pregnancy, the TWW is an unfamiliar term. Once, I mentioned that I was currently in the TWW to a friend who had recently had a baby. She scrunched her face and shook her head in lack of understanding. She hadn’t had to wait like I did.
The two-week wait is the necessary 14 days between ovulation and the start of the next menstrual cycle. During this time, a sperm and egg meet to form an embryo that is then implanted into the uterus, causing enough of a spike in hormones for a positive embryo. Implantation often occurs at six to 10 days past ovulation and some women notice signs of cramping and spotting. Doctors often instruct patients not to test until those two weeks are up to avoid a false negative.
In previous cycles, I had notice that there was a shorter passage of time between when my body ovulated and my cycle began. This is often known as a luteal phase defect, meaning that the body is not producing enough progesterone which is needed for pregnancy. I initially explained this concern to my doctor, and he told me that in every cycle, including the non-medicated ones, that he would put me on a progesterone supplement. This seemed appropriate to me. I had heard a few stories online of women who had experienced luteal phase defect and were able to get pregnant with the introduction of progesterone. My doctor did not officially give me a diagnosis of luteal phase defect but did start me on a progesterone medication two days after my IUI.
The progesterone medication was a vaginal suppository that caused a mess and was uncomfortable to take at times. It also cost $300. But, it was necessary.
The other downside of the medication was that it caused bloating, soreness in the breasts, cramping, and nausea—all symptoms of pregnancy as well as an upcoming menstrual cycle. About a week after the IUI treatment, I was feeling pretty awful. I had tons of cramping and nausea. A nasty habit of the two-week wait is to constantly monitor symptoms and google them. In the second week, I spent hours researching symptoms on trying to conceive (TTC) and infertility message boards, all looking for women who had similar symptoms that lead to their BFP (big fat positive—the fertility world has its own lingo). One day I would be convinced I was pregnant, and the other not. Because the symptoms are so similar between pregnancy, period, and the medication, it was never clear what I was experiencing. The only true measurement was a pregnancy test.
When I scheduled my IUI, I also made an appointment for a pregnancy test via blood work two weeks and a day later. My nurse did not mention that I shouldn’t take a home pregnancy test, and at first, I resolved not to do so. However, on days 9, 10, and 11 past the IUI, my temptation increased. This is still quite an early time for a positive, but it is not unheard of. On day 11, I couldn’t hold my patience anymore and took a “cheapie,” which is a thin piece of paper that one is to dunk in urine. It’s less reliable than the pregnancy tests advertised on TV but, as the nickname indicates, cheaper. It was negative, but I wasn’t discouraged. It was still early, plus I had taken it later in the day when tests should be done in the morning for the most accurate results. Also, the test was old and expired. Although negative, my curiosity was met enough to wait for my bloodwork, and I knew I wasn’t out yet.
The weekend before my pregnancy test, I had two social engagements, which were again nice distractions. Both would involve alcohol, which would be a bummer to refrain from but necessary. The first was a meetup with my internship co-workers, most of whom I had known a year but never met in person due to virtual work. An hour before the get together at a colleague’s house, I noticed some spotting. It was light. Maybe it was related to implantation. It was late in the cycle for that but not unheard of. There was a chance it was my period, which was several days late, but the progesterone medication was known to delay menstruation even if I was not pregnant. To keep my anxiety in check, I went to the bathroom several times throughout the evening. The spotting was light, if at all. Each time there was nothing, my hope spiked that it was indeed implantation.
The next morning, the spotting was about the same and I noticed a bit on the progesterone applicator. I cried a bit thinking maybe it was the period, but then after a pep-talk with my husband, I was again hopeful for implantation. We prepared for our second party, and I bought non-alcoholic beer.
The party was a small celebration with friends to recognize my graduation. The city was slowly starting to open up, and we were resuming social activities. We had planned this as an outdoor gathering by the beach, which allowed us to safely socialize. However, it began raining while we were shopping for beverages and snacks. I panicked a bit, hoping I didn’t have to cancel my party, and thought about moving it back. Because of our overly anxious dog and small apartment, we couldn’t host this gathering. A good friend, with a bigger and nice condo, offered her place for a meeting location. Getting ready for the party, I felt hopeful. I was going to see some good friends to honor my three years of hard work, and there was still a chance I was pregnant.
Right before we walked out the door, I ducked into the bathroom for one “just in case” pee. There it was, red. Lots of red. Despite the medication, my period had persevered.
I was not pregnant. Our first IUI had failed.
Heather M. Mangan 